Preventing Unplanned Perioperative Hypothermia in Children

Beedle, Susan E.; Phillips, Amy; Wiggins, Shirley; Struwe, Leeza

doi:10.1016/j.aorn.2016.12.002

Cited by 15 publications

(9 citation statements)

References 30 publications

(63 reference statements)

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“…The generally suggested operating room temperature is 20-23.9°C, but it is around 23-24°C for pediatric cases (2,8). This value was maintained for all operations performed in this study.…”

Section: Discussionmentioning

confidence: 56%

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Comparison of Forced-air Warming Systems and Intravenous Fluid Warmers in the Prevention of Pediatric Perioperative Hypothermia

Erdoğan¹,

Işıl²,

Türk³

et al. 2019

Haseki

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We aimed to compare the efficacy of intravenous bloodfluid warming and forced-air warming systems for the prevention of perioperative hypothermia in pediatric patients under six years of age. Methods: Two-hundred children aged 0-6 years, who underwent elective surgery, were included in the study. Group 1 patients were warmed with forced-air warming system at the operating room. Group 2 patients were warmed with intravenous fluid and blood warming systems at the operating room. During the entire operation, heart rate, SpO 2 , end Tidal CO 2 and esophagus temperature values were recorded at 10-minute intervals. The number of patients, who needed rescue warming, the starting time and duration of rescue warming were recorded. The duration of the anesthesia, the duration of the operation, and the time of recovery were recorded. Results: The groups were compared in terms of mean operating room temperature and body temperature and no statistically significant difference was found between the groups. There was no statistically significant difference between the groups for additional rescue warming need and time to rescue warming. The time to recovery was longer in the patients who needed rescue warming. There was a statistically significant positive correlation between the duration of the operation and the duration of the need for rescue warming with a confidence of 99%. Conclusion: In pediatric patients, i.v. fluid warming systems are as effective as forced-air warming systems in avoiding perioperative hypothermia.

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Section: Discussionmentioning

confidence: 56%

“…Beedle et al (8) have found the incidence of pediatric perioperative hyperthermia to be 16.3% and that this rate can fall to 1.84% with an attentive perioperative care (that is based on the guidelines).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Forced-air Warming Systems and Intravenous Fluid Warmers in the Prevention of Pediatric Perioperative Hypothermia

Erdoğan¹,

Işıl²,

Türk³

et al. 2019

Haseki

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“…Frequent temperature monitoring coupled with standardized interventions (e.g., warming blankets) reduced unplanned hypothermia incidence from 16 percent to 1.8 percent (Level III Evidence). 41…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

Mountziaris

Rudolph

Fournier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines. Methods: A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. Results: Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients. Conclusions: Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.

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“…Two large studies reported relatively high rates of PH in the pediatric surgical population: Beedle et al documented a PH rate of approximately 20% in 1504 patients, and Pearce et al reported a rate of PH of 53% on 530 pediatric patients. 1,19 Although Kim et al found that only 6% of pediatric neurosurgery patients were hypothermic on arrival to the postanesthesia care unit (PACU), this is misleading because patients are least likely to be hypothermic at the end of a case given that standard operating room (OR) care involves a forced air warmer (FAW) and operative draping provides a good deal of insulation. 14 Not only are patients at significant risk, but current OR culture may not even prioritize a workflow fostering perioperative normothermia: a Europe-wide survey indicated that a mere 40% of patients were warmed intraoperatively and temperature was measured in only 20% of cases.…”

Section: Mutchnick Et Almentioning

confidence: 99%

Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population

Mutchnick

Thatikunta

Braun

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPerioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors’ aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population.METHODSA prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group—WG). The remaining 82 patients received no extra warming care during their perioperative period (control group—CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively.RESULTSWG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group.CONCLUSIONSPreoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.

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Preventing Unplanned Perioperative Hypothermia in Children

Cited by 15 publications

References 30 publications

Comparison of Forced-air Warming Systems and Intravenous Fluid Warmers in the Prevention of Pediatric Perioperative Hypothermia

Comparison of Forced-air Warming Systems and Intravenous Fluid Warmers in the Prevention of Pediatric Perioperative Hypothermia

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population

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